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General NPI Number Information
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NPI Number | 1114900016
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Entity Type | Individual
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Provider Name | FAIZ M UDDIN MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 800 W LINCOLN TRAIL BLVD STE 102
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City | RADCLIFF
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State | KY
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Zip | 40160-2671
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Country | US
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Telephone | 270-351-3515
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Fax | 270-351-7506
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Provider Business Mailing Address
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Address Line | 175 MARY LEE ST
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-4481
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Country | US
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Telephone | 859-539-9905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | KY38224
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036110727
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License Number State | IL
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